Tuesday 19 February 2013

Doctors on Strike

(My first Article published in The News on 31st January, 2013)

A cat and mouse game is raging on between Young Doctors and Government of Punjab. There is a set pattern being followed by both sides, based on earlier skirmishes in the last two years. The primer is usually an untoward incident involving young doctors. As a consequence,there is outrage from young doctors while the government announces some form of committee to sort out the problem. Nothing discernible happens for next few weeks/months. Doctors come out on the streets and OPD(Out Patient Departments) are closed. A few individuals are dismissed from service by the Government and a few people are arrested. As a last resort, doctors announce withdrawal of emergency services, crippling the already overloaded public health system. Within a few days, some makeshift solution is cobbled up and things go back to normal. This routine is being followed for last 2 years and if things remain as they are, can be repeated this time as well.

Young Doctors have been branded assassins and mercenaries, devoid of all humanity,  sacrificing all moral values to bargain for their demands. Hundreds of doctors have been terminated  over the last two years, and dozens have been jailed. A vicious propaganda campaign was designed last year, costing the public exchequer more than 400 Million Rupees  to malign doctors. There is little understanding of the issue plaguing doctors in this country and they are seen with derision and contempt because they have the temerity to demand their rights. The most prevalent misunderstanding about the doctors’ protests is the belief that they are demanding a pay raise. While this was true two years ago, the issue of pays was resolved. Let me clarify that it is not mentioned anywhere in the Hippocratic or any other medical oath that doctors ‘have’ to provide medical care regardless of the conditions. Regarding the morality of strikes, Awais Aftab, a fellow doctor, explained,

A doctor enters into a contract with the society only by virtue of his contract with the Government, therefore, if the Government refuses to honor its obligation of providing adequate facilities and working conditions for the doctors, then the doctors’ obligation to work for the Government becomes questionable. This includes the issue of pay and service structure. If the amount of work and the circumstances in which they are expected to perform deviate significantly from the pay and facilities they are receiving, Government is violating its obligations. This can be augmented by a utilitarian justification. If the short-term harm brought about by the strike is balanced by a long-term benefit to the society in the form of an improvement in health-care, virtue of the fact that doctors can work more efficiently in better working conditions, then a strike is justified. But this utilitarian argument can only be an augmentation, not the crux, because we all know that human lives cannot be added and subtracted.”

The Prime demand of doctors is provision of a better service structure. The current structure is dependent totally on the whims of Baabus at Civil Secretariat who consider doctors as inferior and despicable species. There is no uniform system of promotion. I have documented cases of different doctors who graduated in the same year, from the same college, and having similar qualifications, where one of the two was promoted as a Professor and the other is still in grade 18. Hundreds of “relics of the past” are occupying positions in Major cities while young doctors are transferred to far flung areas. Professors of respective wards are kept busy in administrative affairs, affecting teaching schedules and regimes. Induction of doctors on Medical Officer posts is done via Federal Public Service Commission(FPSC). There were no inductions on regular seats for more than 15 years in the last two decades, contract employment was favored instead. Young Doctors in most major hospitals live in dilapidated hostels, single rooms shared by upto three people. More people do house jobs without any pay than those who get pay. These issue are important when you are doing more than 60 hours work per week without any reward.   

In November 2012, an agreement was reached between Young Doctors and Government of Punjab that the new service structure would be implemented. Two months after that understanding  there was no sign of implementation. The dispute over non-renewal of contracts and housing allowance was simmering in District Head Quarters(DHQ) Hosiptal Gujrawnala as a direct consequence of the non-implementation of doctors’ demands. A team of interlocutors from Lahore was there on 2nd January 2013 when the whole scene got ugly, resulting in physical violence by doctors and by hospital administration. It was broadcast on live television across the nation with some spiced up subtitles. As a result, more than a dozen doctors were arrested and are still in Jail. OPDs(Out Patient Departments) are closed throughout the province in protest and a major ‘Dharna’ has been planned for 7th February 2013.

Personally, I do not endorse the physical violence unleashed by young doctors in Gujranwala and want an impartial inquiry into the matter. Apart from that, I stand by the doctors’ community in the struggle for the proposed(and agreed-upon) service structure. Government of Punjab has tried all sorts of delaying tactics including court delays, invitation to 200 Army doctors, induction of substandard doctors during the strikes and police torture. As a doctor and as a human being, I hope the issue is resolved completely this time, or both sides are going to lose.

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